Management of Fracture Risk in Patients With Parkinson's
Within the general population, osteoporosis is common, often asymptomatic and therefore insidious. The consequences, primarily fractures, represent a significant societal burden, both through direct medical costs (UK > £2 billion/annum) and important social sequelae. Approximately 1 in 2 women and 1 in 5 men aged >50 years will go on to sustain a fracture during their lifetime. In England and Wales, an estimated 76,000 older adults fracture their hip each year.
Several retrospective studies have identified an increased fracture risk in PD patients, particularly of the hip. Recent findings from the UK Clinical Practice Research Datalink (CPRD) demonstrated a doubling of overall osteoporotic fracture risk and tripling of hip fracture risk in PD patients compared with controls. Further UK analyses of over 3 million primary care patients identified a 2-fold [95% confidence interval 1.8, 2.4] hazard of hip fracture for women with PD and 3-fold [2.4, 3.8] for men, even after accounting for multiple independent risk factors. Across North America, Europe and Australasia, women reporting PD have an unadjusted 3.9-fold [2.8, 5.4] increased hazard of fracture over 3 years. Hip fractures occur relatively early in PD, with median duration from PD diagnosis to first hip fracture being 4 years [inter-quartile range: 1.0, 7.3], such that almost three-quarters of hip fractures occur in mild–moderate disease (Hoehn & Yahr stages I–III). As most anti-resorptive agents only take effect after 1 year, early fracture risk assessment is strongly indicated.
Even accounting for poorer pre-fracture mobility, the consequences of hip fracture for a PD patient are worse than among the general population, corresponding to higher pressure sore rates, a more than doubled hospital length of stay and a greater proportion of bed/wheelchair dependency after 30 days. PD-specific mortality rates after hip fracture are unknown, but are likely greater than the general population. Women with PD underappreciate their own fracture risk; 68% considered their risk 'the same or lower than women of the same age' in one prospective study. This may reflect absence of bone health assessment from PD guidelines with consequent inattention by doctors.
Increased Fracture Risk in PD
Within the general population, osteoporosis is common, often asymptomatic and therefore insidious. The consequences, primarily fractures, represent a significant societal burden, both through direct medical costs (UK > £2 billion/annum) and important social sequelae. Approximately 1 in 2 women and 1 in 5 men aged >50 years will go on to sustain a fracture during their lifetime. In England and Wales, an estimated 76,000 older adults fracture their hip each year.
Several retrospective studies have identified an increased fracture risk in PD patients, particularly of the hip. Recent findings from the UK Clinical Practice Research Datalink (CPRD) demonstrated a doubling of overall osteoporotic fracture risk and tripling of hip fracture risk in PD patients compared with controls. Further UK analyses of over 3 million primary care patients identified a 2-fold [95% confidence interval 1.8, 2.4] hazard of hip fracture for women with PD and 3-fold [2.4, 3.8] for men, even after accounting for multiple independent risk factors. Across North America, Europe and Australasia, women reporting PD have an unadjusted 3.9-fold [2.8, 5.4] increased hazard of fracture over 3 years. Hip fractures occur relatively early in PD, with median duration from PD diagnosis to first hip fracture being 4 years [inter-quartile range: 1.0, 7.3], such that almost three-quarters of hip fractures occur in mild–moderate disease (Hoehn & Yahr stages I–III). As most anti-resorptive agents only take effect after 1 year, early fracture risk assessment is strongly indicated.
Even accounting for poorer pre-fracture mobility, the consequences of hip fracture for a PD patient are worse than among the general population, corresponding to higher pressure sore rates, a more than doubled hospital length of stay and a greater proportion of bed/wheelchair dependency after 30 days. PD-specific mortality rates after hip fracture are unknown, but are likely greater than the general population. Women with PD underappreciate their own fracture risk; 68% considered their risk 'the same or lower than women of the same age' in one prospective study. This may reflect absence of bone health assessment from PD guidelines with consequent inattention by doctors.